completing the Patient Registration section, the next step in the patient visit
process is Claim Entry. Post all charges
contained in the Claim Entry section of the workbook.
|Rocky Shore pg 181|| West Point pg 325 |
|Rocky Shore A pg 135|| West Point A pg 315 |
|Rocky Shore B pg 193||West Point B pg 365|
|Rocky Shore C pg 249|| Sunset Springs pg 595 || Maple Hills pg 779 ||Hidden Cities pg 901|
Select the Claim –F1 to enter each encounter form (claim).
Review the Buttons
It is important to become familiar with and understand the functionality of the buttons in Claim –F1. The buttons are:
Add: Select this if you want to add this claim to a patient other than the one listed in the top blue bar. In other words, you are working on a new patient and need to Select Patient at the beginning of your claim entry. After you have retrieved your patient, its defaults display.
Add for Active Patient: Select this if you want to add this claim to the patient listed in the top blue bar (which is considered your active patient).
Find for Active Patient: Select this if you want to view or update a claim for the patient listed in the blue bar (active patient). You can also make changes/updates to this claim and click the Save button.
Find: This enables you to perform a search for an existing claim for any patient. You can also make changes/updates to this claim and click the Save button.
Import: Not applicable.
There are eight tabs across the top of each claim. The first three tabs contain all the necessary information to complete the CMS-1500 form.
1. Claim: Contains rendering and referring provider, facility and insurance information, and claim authorization #.
2. Charges: Enter ICD codes, CPT codes, and all relevant charges and payments.
3. Additional Info: Enter accident information, hospitalization, unable to work, and last menstrual period dates.
4. Insurance: View patient’s current payer and update ID numbers.
5. Activity: View transactions for this claim.
6. Notes: Not applicable.
7. Documents: Not applicable.
8. Review: Not applicable.
How Many Claims Per Patient?
It is important to verify the number of claims your assignment requires. This information is located in the third column on the Patient Listing report in the workbook.
|Rocky Shore pg 110|| West Point pg 280 |
|Rocky Shore A pg 108|| West Point A pg 298|
|Rocky Shore B pg 168||West Point B pg 348|
|Rocky Shore C pg 226|| Sunset Springs pg 546 || Maple Hills pg 702 || Hidden Cities pg 848|
Add a New Claim to a Patient
Before assuming you need to Add a claim, it is important to verify the number of claims your assignment requires.
To add a claim to a patient, click the Add or Add for Active Patient button.
1. If you click the Add button, you must immediately click the Select Patient button and search for the desired patient.
2. If you click the Add for Active Patient button, the patient name that is listed in the top blue bar will populate in the 1 Claim tab.
Find an Existing Claim
You can retrieve an existing claim to fix errors. To find a claim, click the Find or Find for Active Patient button.
Most of the previously entered patient information will default here. Double check the information that does default, and complete the remaining fields.
* Should be defaulted from the initial Patient –F2 entry.
** Needs to be completed with claim information provided in the workbook .
1. Claim Complete: All claims will save as Complete, unless when you click the Save button, an information screen informs you that your claim is incomplete and asks if you would like to continue to save as “incomplete.” If you choose to save your claim as incomplete, you must remember to get the appropriate information and enter it in the incomplete claim, and then reselect Claim Complete - “Yes” and click the Save button. A claim complete “NO” results in a score of 0 (zero).
2. *Select Patient: When you are adding a claim, you will need to search for your patient here. Once selected, the defaults from the patient registration process will populate.
3. *Select Rendering Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient tab. Listed at the top of the encounter form is the provider who is treating the patient.
4. Select Billing Provider: This field will default from the rendering provider field.
5. **Select Referring/PCP Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient tab. You can also select it here.
6. **Select Facility: If a provider mainly sees patients at a clinic, but happens to perform procedures at a facility, the facility is indicated on the encounter form for you to enter. If you select a facility, you must use a POS (Place of Service) code of either 21 or 22 (In-Patient or Out-Patient, respectively) when completing the 2 Charge tab.
2 Charges Tab
Next, enter the ICD (diagnostic codes), Dates of Service(s), POS, TOS, CPT, Modifiers, Unit Price, Units, Total Charges, and Payment made in the office at that time of the visit. Press Tab on the keyboard to continue to the next field. Screen fields and their description are as follows:
1. ICD #: Enter the ICD (diagnostic) code [including period (.)].
2. Set Rows: Set the number of rows to the number of procedure codes you need to enter.
3. From / To: The “From” date of service and “To” date of service.
4. POS: Place of Service; see
dropdown for selection. It defaults 11 for
office, but if you have chosen a facility under the
1 Claim tab, you will choose POS 21 or 22 (In-Patient or Out-Patient, respectively).
5. TOS: Enter Type of Service; see dropdown for selection. Your choice should relate to the section in which the procedure code is found in the CPT manual.
6. CPT: Enter the charge code that indicates the procedure performed.
7. M1, M2, M3, M4: Means Modifier 1, Modifier 2, etc. You can enter up to 4 modifiers per charge.
9. Unit Price: Enter the price of the procedure.
10. Units: Enter the number of times this CPT code is performed.
11. Total Charges: Auto-calculates to equal unit price multiplied by units (unit price x units = total charge).
12. Status: Defaults based on if the payer is electronic or paper.
13. Copay: Amount and method to be entered if indicated on the encounter form.
3 Additional Info Tab
Sometimes important boxes on the CMS-1500 form need to be completed, and these fields are under this tab. Notice the fields are indicated by their corresponding box on the CMS-1500 form.
The most common boxes to complete under this tab based on the information on the encounter forms are:
Box 14: Date of Onset of Illness or Accident (or Injury).
Box 16: Date unable to work; “From” and “To” dates.
Box 18: Hospitalization dates; if the current claim is a result of a prior hospitalization, enter the dates here.
Last Menstrual Period date (box 14).
4 Activity Tab
Save Your Work and Print the Claim
After completing the 1 Claim tab, 2 Charges tab, and 3 Additional Info tab, it is time to save and/or print the claim.
If you don’t want to Save your work, click the Close button.